前路小切口人工髓核置换术治疗退变性腰椎间盘疾患的远期效果

Long-term outcomes of prosthetic disc nucleus placement via anterior mini-open approach for degenerative lumbar disc disease

中文关键词:  退变性腰椎间盘疾患  人工髓核置换术  小切口  疗效  远期

英文关键词:Degenerative lumbar disc disease  Prosthetic disc nucleus replacement  Mini-open approach  Outcomes  Long-term

中文摘要:

  【摘要】 目的：分析前路经小切口行人工髓核 （prosthetic disc nucleus，PDN）置换治疗退变性腰椎间盘疾患的远期效果。方法：2003年6月～2004年9月共行前路L4/5单间隙PDN置换术12例，其中男4例，女8例，年龄18~42岁，平均28.5±8.4岁。腰椎间盘突出症10例，椎间盘源性腰痛2例。术前、术后3个月、术后1年和末次随访时行腰、腿痛视觉模拟评分（visual analoge scale，VAS）和Oswestry功能障碍指数（ODI）评定，应用MacNab标准评价临床疗效，影像学观察假体位置、手术及上位相邻节段椎间隙高度和腰椎运动范围（range of motion，ROM），并进行统计学分析。结果：术后随访60～89个月，平均73.6±8.3个月，腿痛与腰痛VAS、ODI评分术后3个月与术前、术后1年与术后3个月比较有显著性改善（P<0.05），末次随访与术后1年比较无显著性差异（P>0.05）；手术节段椎间隙高度术后3个月与术前、术后1年与术后3个月比较有显著性增加（P<0.05），末次随访与术后1年比较无显著差异（P>0.05）；手术上位相邻节段椎间隙高度术后3个月、术后1年与术前比较无显著性差异，末次随访与术后1年比较无显著性差异（P>0.05）；腰椎ROM术后3个月与术前、术后1年与术后3个月比较无显著性差异（P>0.05），末次随访与术后1年比较有显著性减少（P<0.05）。随访过程中无假体脱入椎管、移位和位置不良，末次随访时MacNab优良率为83.3%，MRI T2加权像显示手术节段椎体终板均出现Modic改变。结论：通过前路小切口进行PDN置换可有效防止假体脱入椎管，长期改善临床症状、恢复手术节段椎间隙高度，维持邻近节段椎间隙高度，但手术节段终板损伤较为常见。

英文摘要:

  【Abstract】 Objective：To analyze the long-term outcome of prosthetic disc nucleus（PDN） placement by mini-open retroperitoneal approach for degenerative lumbar disc disease.Method：12 cases with degenerative disc disease underwent single PDN placement from June 2003 to September 2004.There were 4 males and 8 females with the average age of 28.5±8.4 years old.There were 10 cases of lumbar disc herniation and 2 cases of discogenic low back pain.Visual analoge scale（VAS） score for leg and low back pain，and Oswestry disability index（ODI），MacNab clinical efficacy，PDN location，intervertebral height in diseased level or above and lumbar range of motion（ROM） at preoperation，3 months，1 year and final follow-up after surgery were reviewed statistically.Result：The average follow-up was 73.6±8.3 months.As for VAS leg and low back pain score and ODI score：significant differences（P<0.05） were noted between 3 months′ follow-up and preoperation as well as between 1 year and 3 months′ follow-up，however no difference between final and 1 year follow-up（P>0.05）.As for diseased disc height：significant difference（P<0.05） was showed at 3 months compared with preoperation and 1 year，but no difference between final follow-up and 1 year was noted（P>0.05）.Adjacent proximal disc height remained unchanged till 1 year，but no statistical difference was noted between final follow-up and 1 year（P>0.05）.Lumbar ROM at 3 months showed no statistical difference compared with preoperation and 1 year respectively（P>0.05），and statistical difference was noted between final follow-up and 1 year（P<0.05）.MacNab scale showed excellent to good ratio of 83.3%.No PDN displacement was noted.Modic change occurred at diseased level in all patients at final follow-up under T2-weighted MRI.Conclusion：Anterior mini-open retroperitoneal PDN placement for degenerative lumbar disc disease can improve outcome and prevent PDN displacement as well as restore adjacent segment height，however end-plate injury of diseased disc is common.